Healthcare Provider Details

I. General information

NPI: 1205629359
Provider Name (Legal Business Name): SUMMIT MEDICAL HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 CRIMSON CANYON DR STE 110
LAS VEGAS NV
89128-0848
US

IV. Provider business mailing address

2670 CRIMSON CANYON DR STE 110
LAS VEGAS NV
89128-0848
US

V. Phone/Fax

Practice location:
  • Phone: 702-232-3189
  • Fax: 702-726-9543
Mailing address:
  • Phone: 702-232-3189
  • Fax: 702-726-9543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHERRYL TAKAHASHI
Title or Position: BILLING MANAGER
Credential:
Phone: 702-233-6196